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Lismore City

Council Social Justice and Crime

Prevention Committee

Findings & Recommendations

May 2019

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Table of Contents The Resolution of Lismore City Council ............................................................. 3

The Committee Members ...................................................................................................... 3 The Committee Meetings ...................................................................................................... 3

Foreword ........................................................................................................................ 4 Dr Alex Wodak - President, Australian Drug Law Reform Foundation .................................. 4

Jordan’s Story ................................................................................................................. 6

Executive Summary and Recommendations .................................................... 7 Background to the issues in our region ..................................................................... 7

The War on Drugs must end – Substance Use Disorder is a Health Issue ............................. 9 Current court diversionary programs ....................................................................... 11

Magistrates Early Referral Into Treatment (MERIT) ........................................................... 11 Extra Offender Management Service (EOMS) ..................................................................... 12

Why we need a Drug Court in our region ...................................................................... 13 Current rehabilitation services in our region ............................................................ 15

Riverlands Drug and Alcohol Centre .................................................................................... 15 The Buttery Therapeutic Community .................................................................................. 16 The Buttery Private.............................................................................................................. 16 Byron Private ....................................................................................................................... 17

Why we need further residential rehabilitation centres ................................................ 17 Current Aboriginal-Specific Rehabilitation Services ................................................. 19

Balund-a Program ............................................................................................................... 19 Rekindling the Spirit ............................................................................................................ 20 Namatjira Haven ................................................................................................................. 20

Why we need culturally appropriate residential rehabilitation services for Aboriginal women and for women and children ............................................................................ 21

Why we need Dual Diagnosis residential rehabilitation services ................................... 22

Why we need a Youth and Adult Koori court ................................................................ 24

Why we need Justice Reinvestment Initiatives .............................................................. 26 The statistics of our region ...................................................................................... 28

Lismore LGA ......................................................................................................................... 29 Richmond Valley LGA .......................................................................................................... 29 Ballina LGA .......................................................................................................................... 29 Kyogle LGA .......................................................................................................................... 29 Byron Bay LGA ..................................................................................................................... 30 Tweed LGA........................................................................................................................... 30

Recommendations from the Upper House Inquiry on the Provision of Drug Rehabilitation Services in Regional, Rural and Remote New South Wales that the Committee supports ................................................................................................ 32

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The Resolution of Lismore City Council

1. On 10 April 2018, Lismore City Council resolved that Council bring together a group of key community stakeholders to form a Social Justice & Crime Prevention Committee aimed at identifying the needs and demand in our region for:

• A Drug Court • A further Residential Rehabilitation Centre • A Youth and Adult Koori Court • Justice Reinvestment Initiatives 2. Council note the work being undertaken by Dubbo Regional Council in

forming a similar committee to identify and address social problems; 3. That the Committee reports their findings back to Council by April 2019.

The Committee Members Councillor Eddie Lloyd, Chair Councillor Darlene Cook Councillor Vanessa Ekins Councillor Adam Guise Councillor Neil Marks Mayor Isaac Smith Office of the Director Public Prosecutions – Lismore Department of Community Corrections – Lismore Aboriginal Legal Service - Lismore Legal Aid – Lismore Lismore City Council Aboriginal Advisory Group The Buttery Residential Rehabilitation Centre Women Up North Housing Namatjira Haven Ltd Rekindling the Spirit Jordan Keogh 3VC Tracey Kristiansen Sophie Anderson – Barrister – Commercial Bank Chambers Ben Cochrane – Barrister – Commercial Bank Chambers Kylie-Anderson Clarke – Criminal Defence Lawyer The Committee Meetings

• 13 June 2018; • 25 July 2018; • 26 September 2018; • 21 November 2018; • 11 April 2019.

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Foreword

Dr Alex Wodak - President, Australian Drug Law Reform Foundation “It is hard to find a family in Australia not touched by at least one member having serious alcohol and drug problems. Yet people who want to overcome their problems very often find that obtaining professional help is extremely difficult or even impossible. Services in rural and remote areas are even harder to find. People with problems due to illicit drugs face even more severe stigma and consequences arising from illegality of drugs. Like most other countries, for almost a century Australia has relied heavily on law enforcement to try to keep illicit drugs under control. Yet in that time, the drug market has grown considerably and also become much more dangerous. During the last half-century deaths, disease, crime, corruption and violence related to drugs or drug policy have increased considerably. There is a growing acknowledgement that the War on Drugs approach, notwithstanding its political benefits for its advocates, has been an abject failure. Mr Tony Abbott, the (then) Prime Minister, said on 29 April 2014 that the war on drugs was not a war that could be won but is a war that could be lost. On 14 March 2019, the United Nations Chief Executive Board comprising the leaders of 31 major UN organisations voted unanimously to encourage countries to consider the decriminalisation of drugs. Several retired but also serving Police Commissioners in Australia have commented publicly that this country cannot arrest or imprison its way out of its drug problems. The threshold question for drug policy is whether to adopt a predominantly law enforcement or a predominantly health & social response to illicit drugs. Australian governments have allocated 66% of expenditure in response to illicit drugs to law enforcement attempts to reduce drug supply with 22% to drug treatment, 9% to prevention and only 2% to harm reduction. While identifying benefits from customs, police, courts and prison is a challenge, severe collateral damage is self-evident. In contrast, treatment and harm reduction produce obvious benefits and little unintended negative consequences. Many governments around the world have started changing their framework. Early results are encouraging. They have taken the threshold step of redefining illicit drugs as a predominantly health and social issue. Drug treatment is being expanded and improved towards the level of other health services. In a number of countries, penalties for possession of personal quantities of illicit drugs have been scrapped. Some countries have started to regulate as much of the drug market as they can with legal needle and syringe programs, drug consumption rooms, Heroin Assisted Treatment, pill testing and taxed & regulated recreational cannabis.

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It is encouraging that the Lismore City Council Social Justice and Crime Prevention Committee is following in this style. Australia was once a world leader in drug policy but has become a laggard. Drug law reform in federal countries has its own complexities. This makes grass roots local reform all the more attractive. I hope their proposals will be welcomed and funded. People with drug problems are our sons and daughters, our sisters and brothers, and our mothers and fathers. They are us. We have tried punishing them for decades with miserable results and vast expense. It is time we tried helping them to lead normal and productive lives.” Dr Alex Wodak President, Australian Drug Law Reform Foundation Emeritus Consultant, Alcohol and Drug Service, St Vincent's Hospital Visiting Fellow, Kirby Institute, UNSW Director, Australia21

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“Not every story has a happy ending, ... but the discoveries of science, the teachings of the heart, and the revelations of the soul all assure us

that no human being is ever beyond redemption. The possibility of renewal exists so long as life exists. How to support that possibility in

others and in ourselves is the ultimate question.” ― Gabor Maté, In the Realm of Hungry Ghosts: Close Encounters with

Addiction

Jordan’s Story My name is Jordan and I’m an addict. The first time I said these words I didn’t really know what they meant but I knew I had a problem with alcohol and drugs and that I needed help. I was twenty-five years old and had just crashed a car in a blackout from drinking and taking drugs. One of my passengers tragically died in the backseat of my car that night. Broken as a man from what I had done, I admitted myself into a long-term rehab to try to address my issues and discover how and why my drinking progressed to a point that I lost total control over the amount I took and decided to drive in that state. Aside from learning that I had been irresponsible, selfish and acting the fool, which I was, I also learned that I had a serious health condition and that I wasn’t a bad person trying to be good, rather I was a sick person trying to get well. The initial relief I felt hearing this statement was quickly silenced by the voice in my head that said “that’s just an easy excuse to justify your behaviour and is a cop out for you to find an easy way out”. I was torn with the idea I had a legitimate health issue. I had to discover whether what I was hearing was the truth or just some platitudes by a group of sober drunks trying to justify their behaviour and avoid taking ownership of their actions. I was stunned to learn I was a ticking time bomb from the time I was young to become addicted to alcohol and drugs and in the light of my experience it was so sad to revisit my past and see the progression of my addiction play out just like the science said it would. It was like watching a tragic movie except it was real life, my life that was on the reel. Today I’m very thankful to be nine years sober and know personally that substance use disorder is a deadly and tragic disease that has the potential to ruin lives just like it did with me. I’m very passionate about trying to help improve the current model of treatment and create more and more loving places of care for people to get well and heal from this deadly health condition. I feel very grateful to be asked to contribute a few words towards this amazing report and I hope and pray that we can help someone, somewhere who is still suffering, unaware of their problem and the possible solutions. Warmest regards Jordan K.

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Executive Summary and Recommendations Lismore is the central hub for legal services in the Northern Rivers and North Coast of NSW. The Lismore legal precinct includes the Local and Children’s court but also includes the District and Supreme Courts which service clients from the Richmond Valley, Kyogle, Byron, Ballina and Tweed Shire Local Government Areas. Over the course of 2018, the Lismore City Council Social Justice and Crime Prevention Committee members shared their personal and professional experiences of the demands, gaps and challenges faced in the drug and alcohol, justice and housing sectors. Our members have found that there is a need and demand in our region for further residential rehabilitation services, a Drug Court, a Youth and Adult Koori Court and Justice Reinvestment Initiatives. In addition, the Committee has found the following needs exist:

1. There is a need for culturally and gender appropriate residential rehabilitation services for Aboriginal women and children, for women and children and for individuals with dual diagnosis;

2. There is a need for detox services for youth; 3. There is a need for the expansion of the Magistrates Early Referral into

Treatment Program (the MERIT program) to adequately address the overwhelming demand and allow individuals with alcohol issues to participate;

4. There is a need for the return of the Life On Track program.

Background to the issues in our region

There is a large amount of criminological literature demonstrating a strong association between substance use and crime. Individuals convicted of crimes

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report a much higher prevalence of substance use disorder than the general population and a large proportion of these individuals attribute their criminal behaviour to their substance use disorder.1

It is widely accepted that substance use disorder is a risk factor for recidivism and returning to gaol and as such is a significant independent predictor of self-reported criminal activity and re-incarceration of parolees.2

BOCSAR statistics reflect drug-related crime in our region is double to three times the state average. It is no surprise that the public perceive, (and the Committee agrees) that the prevalence of methamphetamine (ice) misuse has become a significant challenge in our region and such misuse is too often sadly linked to violent behaviour and criminal offending.

The Committee notes that the cost to the government and tax-payer of drug-related crime and substance use disorder does not just come as a huge economical cost to the government and taxpayer, but also comes at a social cost to our families and communities - a cost that can be difficult to quantify but easy to see.

The Committee agrees that there are many people in our region who suffer from substance use disorders and are unable to access treatment due to shortages in services and difficulty in accessing services to suit the client especially people who experience dual diagnosis such as substance use disorder and mental illness/conditions and/or disabilities. Substance use disorder is particularly problematic in individuals with a comorbid mental health disorder.3

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1Coghlan, S., Gannoni, A., Goldsmid, S., Patterson, E., & Willis, M. (2015). Drug use monitoring in Australia: 2013-14 report on drug use among police detainees (Monitoring Report No. 27). Retrieved from Australian Institute of Criminology website: http://www.aic.gov.au/publications/current%20series/mr/21-40/mr27. html 2 http://www.bocsar.nsw.gov.au/Documents/CJB/Report-2016-NSW-Intensive-Drug-and-Alcohol-Treatment-Program-cjb192.pdf (e.g. Ferguson, 2015; Kinner, 2006; MacKenzie et al., 1999). 3 http://www.bocsar.nsw.gov.au/Documents/CJB/Report-2016-NSW-Intensive-Drug-and-Alcohol-Treatment-Program-cjb192.pdf (Smith & Trimboli, 2010).

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“punishment—shaming a person, caging them, making them unemployable—traps them in addiction. Taking that money and

spending it instead on helping them to get jobs and homes and decent lives makes it possible for many of them to stop.”

― Johann Hari, Chasing the Scream: The First and Last Days of the War on Drugs

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The War on Drugs must end – Substance Use Disorder is a Health Issue

The war on drugs approach has failed, but whilst there exists the criminalisation of drugs it is important to drive change towards a health and social response including de-stigmatising the user to achieve positive outcomes for people. It is also important to embrace opportunities within the community and within the criminal justice system that can enable individuals to access treatment services that they may not normally be able to due to a number of barriers, such as geographical location and most importantly, due to the stigma attached to having a drug and/or alcohol ‘problem.’

The stigma is a significant barrier and one that is further entrenched by inflammatory and loaded labels given to individuals experiencing the disorder, such as ‘ice addicts’ ‘drug addicts’ ‘junkies’. The Committee wish to emphasise that substance use disorder is a health condition listed in the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V). The DSM-V is the handbook used by health care professionals in much of the world, including Australia, as the authoritative guide to the diagnosis of mental disorders.4 The Committee urges all politicians and members of the public to refer to the condition by its diagnostic name – substance use disorder. This will help to re-frame the condition back into the health paradigm and out of the criminal paradigm.

The Committee and particularly members with lived experience, such as Jordan, noted that substance use disorder is a cunning and baffling condition. Committee members emphasised the need for understanding that relapse is a common feature of ones recovery. Relapse rates for substance use disorder are similar to rates for other chronic medical illnesses. Treatment of chronic diseases involves changing deeply rooted behaviours, and relapse doesn’t mean treatment has failed.

4 The DSM V recognises substance-related disorders resulting from the use of 10 separate classes of drugs: alcohol; caffeine; cannabis; hallucinogens (phencyclidine or similarly acting arylcyclohexylamines, and other hallucinogens, such as LSD); inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants (including amphetamine-type substances, cocaine, and other stimulants); tobacco; and other or unknown substances.

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“Relapse, plays a huge role in recovery from Alcohol and other Drugs, and a majority of people more often than not will relapse at least once, throughout their recovery. Having programs that are available to clients 24/7 would be a big help either by phone, Facebook, texting or a drop in centre. In the early stages of recovery, clients need to be nurtured, and guided into finding their pathway to recovery, accessing housing, seeking employment opportunities, and being available to clients to just talk, when require.” – Greg Telford, CEO – Rekindling the Spirit.

The Committee note that all relevant stakeholders would benefit from education about this health condition and the rate of relapse to better inform decisions that benefit the whole community.

“I am concerned at the unaddressed challenges faced by Community Corrections and Parole officers supervising parole periods and bonds in the community. If the parolee/offender has a long-standing substance use disorder and there are no beds available in local rehabilitation centres then it can be very difficult for individuals to overcome the disorder and not reoffend given their offending is often closely linked to their substance use disorder.

Reoffending can mean breaching a bond and returning to court for a harsher penalty or if their parole is revoked and they are sent back into custody with no access to rehabilitation and the cycle continues without end.

Further, there seems to be a lack of understanding among stakeholders that relapse is a common feature of substance use disorder and sometimes it takes many attempts at rehabilitation before abstinence or reducing harmful use can be attained and that there is little opportunity to rehabilitate from chronic substance use disorder if there are no beds at local rehabs.” – Councillor Eddie Lloyd, Committee Chair and Trial Advocate, Aboriginal Legal Service.

Additionally, the Committee is cognisant that not everyone has strong family support, funds or adequate mental health to do what is required to access treatment. People often return to the same issues and circumstances that may have contributed to their drug or alcohol use in the first place. Not everyone has the capacity to wait many months for a bed. Sadly, many are not able to maintain themselves on the waiting list with some dying.

“Methamphetamine (ICE) is very much impacting the lives of many Aboriginal people today and of people from all walks of life, people of all ages...but it is devastating our people. ICE not only affects the people that get addicted to it but it's affecting the families of those ICE users. It affects the parents and the children of those people in very real psychological, physical, emotional and social ways.

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It destroys the family structure, takes our children, our parents, our families from us. I can personally attest to this. I am living with this everyday with my one and only adult child...ICE is the reason that I have had to take custody and care of my one and only grandchild. ICE has destroyed my daughter’s life - though I try everyday to have hope of getting her into long term rehab. ICE is not just a threat in our society, it is very real and very destructive to not only our people but anyone that gets addicted to it and ICE is extremely addictive” – Patricia King - Proud Descendant of Widjabul People Within the Bundjalung Nation and member of Lismore City Council Aboriginal Advisory Group.

Current court diversionary programs

Magistrates Early Referral Into Treatment (MERIT)

The Lismore MERIT office presented to the Committee on 25 July 2018.

Key points raised included:

• 92% (127,227) of the NSW criminal matters are finalised in the Local Court;

• Eligible individuals are able to have their matter adjourned for up to twelve weeks to allow them to focus on treating their substance use disorder and associated social issues;

• MERIT in Lismore is only available for persons with a drug issue, not alcohol;

• MERIT is under-resourced and not always available.

The Committee agree that our region would benefit from an expansion of MERIT services to meet the current demand and enable individuals with alcohol issues to participate.

“Many of our clients come to court with a long standing alcohol abuse background from growing up around it to now experiencing it themselves. MERIT has had great success in assisting people with drug

problems to achieve abstinence and therefore reducing their criminogenic behaviours. Precluding people from the program because they don’t have a drug issue, means that they miss out on the extremely beneficial and successful program which not only benefits them, but in the long term this benefits the community in social and economic ways and ultimately results in a reduction in crime” – Binnie O’Dwyer, Solicitor, Aboriginal Legal Service “MERIT is a program available in most Local Courts in New South Wales that provides the opportunity for adult defendants with

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substance abuse problems to work, on a voluntary basis, towards rehabilitation as part of the bail process. At selected courts, the MERIT Program is available to defendants with a primary alcohol issue (whereas at the majority of courts, entry is restricted to those whose primary concern is illicit drugs). Lismore is not one of these Courts despite the fact that alcohol consumption at levels posing lifetime risk to health is 34% of the population in our region. The Buttery believes an increase in MERIT beds would be necessary if the Lismore Court extended the MERIT program to include alcohol related issues. Traditionally, the Buttery had four (4) beds and is now down to only two (2).” – Leone Crayden, CEO, The Buttery “People’s lives are very much affected by alcohol in very similar ways to people experiencing drug issues...their lives are debilitating and are being destroyed by alcoholism too and so are their families” – Patricia King - Proud Descendant of Widjabul People Within the Bundjalung Nation and member of Lismore City Council Aboriginal Advisory Group. “The MERIT office in our region is often closing its books due to a lack of resources to service the demand in our region. MERIT is only available for individuals with substance issues other than alcohol. Many of our Aboriginal clients have grown up in communities where alcohol use disorder and violence sadly go hand in hand. Our clients are not given the opportunity to do the MERIT program because their substance use disorder involves alcohol. This is a great shame given MERIT can assist them not only to rehabilitate but to engage in courses to address violent behaviours and forge a new path in life. The gap in this service means many reoffend and end up in custody and the cycle continues.” Councillor Eddie Lloyd, Committee Chair and Trial Advocate, Aboriginal Legal Service.

Extra Offender Management Service (EOMS)

Sarah Sherlock from Mission Australia presented to the Committee on 26 September 2018.

Key points raised included:

• Life On Track (LOT) is no longer, despite positive outcomes for many individuals;

• EOMS (Extra Offender Management Service) is the new service but it does not provide the same services as LOT.

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The legal members of the Committee were particularly vocal about their disappointment about the closure of Life On Track, noting the significant and life-changing assistance it provided to those at risk of becoming stuck in a cycle of recidivism due to social, legal and health issues such as housing, substance use disorder, criminal matters and family issues including family violence and custody issues.

The legal members paid tribute to the local Life on Track and EOMS employees who take a holistic approach to their work and go above and beyond for each client, assisting them with getting their lives back on track.

“Life on Track was a fantastic program which many of my clients benefited greatly from. From dealing with their housing needs or getting their teeth fixed or taking them to appointments due to not having a car or licence or both, the case workers were dedicated and assisted our clients to sort out the issues which were causing them to offend. They provided comprehensive reports and the magistrates would give people the time to participate in the program knowing that it would be beneficial not only for them but ultimately the community as well.

I saw people’s lives change dramatically for the better and importantly not re-offend. Then with little consultation, the service was ended and replaced with a smaller version, less staff and it only targets medium risk individuals. EOMS has been a much-reduced program and as such has not had the same impact on our clients. It has still been of assistance but much less so unfortunately and we are seeing clients who require this early intervention not getting them the help and intervention they need to address the risk of reoffending. How can this possibly be good for our community?” – Binnie O’Dwyer, Solicitor, Aboriginal Legal Service

“We want Life On Track back in our region. It worked and then it was reshaped and shrunk to EOMS. There is no longer a service that provides early intervention to our clients which is exactly where intervention is needed to reduce the risk of individuals becoming stuck in the drug/crime cycle.” – Councillor Eddie Lloyd, Committee Chair and Trial Advocate, Aboriginal Legal Service.

Why we need a Drug Court in our region The experience in courts of therapeutic jurisprudence in the United States, the United Kingdom and Canada strongly influenced the establishment of a Drug Court in Parramatta in 1999. The Drug Court now sits in the Sydney CBD and the Hunter Region. The Drug Court was evaluated in 2002 and 2008 by the Bureau of Crime Statistics and its success has ensured it continues today.

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The 2008 re-evaluation of the NSW Drug Court revealed it to be more cost-effective than prison in reducing the rate of re-offending among offenders whose crime is drug/alcohol related. Individuals who progress through the NSW Drug Court are significantly less likely to be reconvicted than offenders given conventional sanctions (mostly imprisonment).5

The current findings estimate that the Drug Court program provides a net saving of $1.758 million per year when compared with conventional sanctions. The long-term savings are even greater because of the reduction in recidivism of offenders who complete the program. In other words it is cheaper and produces better outcomes than the alternative custodial sanction. 6 This conclusion means that the NSW Drug Court is likely to be a cost-effective approach. 7 There is no Drug Court for our region despite the obvious need borne out from the recent and long term BOCSAR statistics and the experiences of our Committee members.

“I worked for the Aboriginal Legal Services in Redfern & Blacktown in Sydney from 2001 - 2003; and during that time, had many clients involved in the Drug Court system, which, at that time, was a new and innovative scheme to assist in diverting offenders from the system, whilst assisting them to deal with their addiction issues. The ingenious nature of the Drug Court, apart from it’s now many documented successes, was the way it was run right from its inception. That is, for a client to be chosen to get into the Court, you had to win a lottery. For many of my clients, who had often never won anything in their lives, to be chosen from the lottery to go to Drug Court, was in their eyes, nothing short of a miracle. A chance. An opportunity to change, and a sign that things were directed towards their rehabilitation. Not only were they appreciative of the opportunity, but they felt like they had finally had some luck come their way. Clients would cry when they were chosen, rejoice and sometimes boast to other inmates.

5 Stephen Goodall, Richard Norman & Marion Haas, The costs of NSW Drug court, (September 2008) Centre for Health Economics Research and Evaluation, http://www.bocsar.nsw.gov.au/Documents/CJB/cjb122.pdf - The economic analysis conducted by CHERE showed that the total cost of the Drug Court program is $16.376 million per annum. The largest drivers of this final cost are the cost of final imprisonment (for those who do not complete the program successfully) and the cost of staffing and running the court. 6 Stephen Goodall, Richard Norman & Marion Haas, The costs of NSW Drug court, (September 2008) Centre for Health Economics Research and Evaluation, http://www.bocsar.nsw.gov.au/Documents/CJB/cjb122.pdf - The economic analysis conducted by CHERE showed that the total cost of the Drug Court program is $16.376 million per annum. The largest drivers of this final cost are the cost of final imprisonment (for those who do not complete the program successfully) and the cost of staffing and running the court. 7http://www.bocsar.nsw.gov.au/Pages/bocsar_media_releases/2008/bocsar_mr_cjb121.aspx

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Naturally, clients flocked for the opportunity to be part of this new scheme and took the program seriously when they were in it; trying sometimes against the odds to succeed. For those clients, it was often their “last chance” not only for the broader community, but also for any vestige of hope they had left in themselves. The successes of clients within the program are now well known. Whilst I didn’t work in the Court regularly, I was familiar with its workings, and did the odd Court appearance there. It had an air about it that was different to other Courts. Still with the all the imprimatur of a Court, but imbued with the hope of those participants, the encouragement to change despite the odds of succeeding, and the drive to amend past wrongs and start a new life, acknowledging the path substance use disorder had taken them on, and actively deciding to leave that life behind. Lismore has a unique opportunity to operate a similar Court given our unique community and location. To embrace the challenges that our community faces due to substance use disorder, and rather than turning our back on people in their deepest time of need, engaging with them on a community & health level, supporting their change so they can overcome the issues leading to their addiction. It is essential we change the “song book” and be a community that is progressive and drives change through a Court program which has been proven for its efficiency and success.” Sophie Anderson, Barrister, Criminal Law – Commercial Bank Chambers - Lismore

Current rehabilitation services in our region

Riverlands Drug and Alcohol Centre Riverlands is a 16-bed detoxification unit, pharmacotherapy clinic (methadone & buprenorphine), clinical liaison and outpatient services and an educational and training facility.8 Riverlands, as a detoxification unit is not a drug and alcohol rehabilitation unit. Riverlands allows people to safely detox under medical supervision as a first phase in the drug/alcohol rehabilitation process.

This service is not available for people under 18 years of age. There is no easy transition from the detox straight to a residential rehabilitation centre given the lack of beds and long waiting lists.

8 NSW Health website http://nnswlhd.health.nsw.gov.au/about/drug-alcohol-services/riverlands-drug-alcohol-centre/, accessed 25 March 2018

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Often there is only a narrow window of opportunity where an individual (after detoxing) accepts that they need help. Unless rehabilitation assistance can be provided whilst the person is within this moment, the opportunity is often lost.

The Buttery Therapeutic Community The Buttery is a residential rehabilitation centre in Binna Burra about half an hour from Lismore and has 34 beds. The Buttery is a therapeutic community (a ‘TC’) and is a long-term residential rehabilitation program for adults addicted to drugs, alcohol or both.9 The program is evidence-based and best-practice and informed by the latest research into addiction treatment. Most people undertake The Buttery’s residential rehabilitation program at no direct cost to themselves and contribute 80% of their Centrelink benefits (e.g. pension or sickness benefits) to cover food and accommodation.

‘The current waiting list is 5-6 months for males & 4 months for females. The discrepancy is due to there being more men seeking rehab and the need to achieve gender balance in the therapeutic community as this is more effective for treatment. We currently have 34 beds on site, however, this is split over two programs. The Therapeutic community runs 24 residential rehab beds and 2 MERIT beds, while the Methadone to Abstinence (MTA) Program operates with 7 beds. The following is more anecdotal than tested and is based on observation and feedback from participants and staff. We have found that around the 30 participant mark is a maximum for a cohesive community. When we have operated with more people on site there is a sense that individuals can get lost in the groups and overall visibility and accountability can fluctuate. As these are core elements to the TC framework the impacts of participant numbers has been a consideration with overall management of throughout.” – Leone Crayden, CEO, The Buttery.

The Buttery Private The Buttery Private is The Buttery’s new social enterprise. Surplus funds from the program are applied to The Buttery’s charitable works. It is a new residential rehabilitation initiative whose focus is on a ‘Wellbeing Program’ 9 “In the Therapeutic Community model of treatment, the community itself, through self-help and mutual support, is the principal means for promoting personal change. In a therapeutic community residents and staff participate in the management and operation of the community, contributing to a psychologically and physically safe learning environment where change can occur. In a therapeutic community there is a focus on social, psychological and behavioural dimensions of substance use, with the use of the community to heal individuals emotionally, and support the development of behaviours, attitudes and values of healthy living.” (Definition provided by Australasian Therapeutic Communities Association.)

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designed to complement medical in-patient (28 day) programs for people who are (prior to entry) physically detoxed and psychologically stabilised. The service is designed for people who may need to take time-out to address the issues underlying their conditions. This is undertaken in a small, confidential residential setting. The Buttery Private is an evidence-based program for people experiencing:

• Workplace burnout • Exhaustion • Stress • Anxiety • Depression • Trauma • Substance abuse10

There are no waiting lists. Fees for treatment are not covered by private health insurance. The cost is less than but comparable to other private facilities. The cost is a barrier for many in participating in this program.

Byron Private The Byron Private is a privately-funded 12-bed residential facility that provides a 6-week treatment program for drug addiction, alcoholism, eating disorders, PTSD, anxiety and depression. Entrance into Byron Private costs around $40,000 for the six-week program. The facility qualifies as a Private Health Facility under the Private Health Facilities Act 2007, therefore the cost of treatment at Byron Private is prohibitive to the overwhelming majority of individuals with substance abuse disorders in our region.11

Why we need further residential rehabilitation centres The term ‘Therapeutic Community’ (TC) is generally used to describe small, cohesive communities where patients (sometimes referred to as ‘residents’) have a significant involvement in decision-making and the practicalities of running the community. Key principles include collective responsibility, citizenship and empowerment, and TCs are structured in a way that deliberately encourages personal responsibility and discourages unhelpful dependency on professionals.12 It is 10 Buttery Private website, https://www.butteryprivate.org.au/for-referrers/, accessed 25 March 2018. 11 Bryon Private submission to the Inquiry into the Provision of Drug Rehabilitation Services in Regional, Rural and Remote NSW, December 2017, p2 12 Julian Stern, Core Psychiatry (Third Edition), 2012 https://www.sciencedirect.com/topics/nursing-and-health-professions/therapeutic-community

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a broad term that encompasses many different models of care. It is acknowledged that there is a need for residential rehabilitation service models to be tailored to different groups in our community. For example, healing centres such as Namatjira Haven is a more appropriate model of treatment for our Aboriginal community. Individuals with substance use disorders are often self-medicating a past trauma. A therapeutic, healing model of community is a safe space which enables participants to let their guard down and share these experiences which leads to gaining insight into how recourse to substances is often a coping mechanism to deal with the pain that may ordinarily feel unbearable. The sharing of ones experiences in this setting leads others to feel comfortable sharing their own pain. It is obvious why the gaol setting prevents rehabilitation in that it is the last place in the world it is safe to let your guard down to discuss past traumas. Additionally, the availability of drugs can be too great a temptation for many in a gaol setting where there exists no real support to assist in rehabilitating. A significant reason attributed to the success of residential rehabilitation in reducing relapse events is that the setting allows individuals to work solely on themselves without the disturbance and interference of life stressors such as family, financial and legal issues, which are usually the triggers for relapse. Residential rehabilitation centres allow individuals to practice relapse prevention strategies when triggers arise and without access to substances that they would normally turn to in such times.

“Getting people to rehab who are in custody is not possible anymore given the recent change to policy that no longer allows clients to use the gaol phone to be assessed by a rehab. This is because lawyers are no longer permitted to apply for Drug and Alcohol Assessment Orders through the court. Then there is the issue of there not being enough beds for any type of rehab. We need more dual diagnosis facilities for people who have complex mental health issues as well as substance abuse issues. We need more women’s and children's facilities. We need more specialised facilities to be able to deal with higher risk offenders who may have criminal histories which prevent them from being eligible for some rehab facilities. There are just so many barriers for our clients who are putting up their hand for help – our clients who want to address their substance misuse issues but there is not enough support out there for them and if they are in custody on remand they have no access to rehabilitation whatsoever. In my opinion this stems from the mentality of needing to punish people as opposed to helping them to heal and rehabilitate and reduce recidivism. Incarcerating people costs the taxpayer an extraordinary amount of money and does nothing to help people

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to stop using drugs. Rehabilitating people is a cost effective way of helping them to become functional, law abiding members of the community and will actually address the disproportionate number of Aboriginal people in custody” – Binnie O’Dwyer – Solicitor – Aboriginal Legal Service

“The Buttery saved my life. It gave me back my family and gave me a purpose to live. I was lucky to have family to support me through the long waiting list period. Sadly, this is not everyone’s experience. I have lost many friends and clients who have relapsed and some who have died waiting on waiting lists. It is frustrating to see people with substance use disorder be criminalised and demonised in the way they are by politicians and some in the community when this is a health issue and these people are putting up their hand for help and ending up on long waiting lists because there is no help for them when they ask for it.” Councillor Eddie Lloyd, Buttery Graduate, Committee Chair and Trial Advocate, Aboriginal Legal Service.

Current Aboriginal-Specific Rehabilitation Services Our region has more than double the number of Aboriginal people than the national and state average.13 A 2017 crime report by BOCSAR indicates there has been a State average increase of 25% in Indigenous imprisonment since 2013. It was reported that in our region there has been a 50% increase in the number of Indigenous people imprisoned since 2013.14 This in itself is good evidence of the shortage of treatment opportunities and need in our region for rehabilitation opportunities for the Aboriginal community. Sadly, there is a high rate of methamphetamine and alcohol related violent offending among the Aboriginal communities in our region. Domestic violence is sadly too prevalent and it is this offending that often results in incarceration. Aboriginal lawyer and academic Noel Pearson has argued that substance use disorder is a far more important cause of Aboriginal incarceration than economic and social disadvantage.15 The Committee agrees.

Balund-a Program On 21 November 2018, Lisa O’Brien, Manager of Balund-a presented to the Committee. 132016 Census QuickStats, Lismore (NSW) http://www.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/SSC12344 14 https://www.northernstar.com.au/news/solution-to-reduce-indigenous-prisoners-in-jails/3199773/ 15 Don Weatherburn, Disadvantage, Drugs & Gaol: Re-thinking Indigenous Over-representation in Prison - Keynote address, Conference of the Australasian Society on Alcohol and other Drugs, Cairns Convention Centre, 5th-8th November, 2006.

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Key points raised:

1. Balund-a is not a drug and alcohol residential rehabilitation service; 2. The Balund-a Program is located at Tabulam and is a residential

diversionary program established in 2015 operated by Corrective Services NSW, for male offenders over 18 years of age and its aim is to reduce re-offending and enhance skills within a cultural and supportive community environment..16

3. Cultural activities include excursions to sacred sites, music, dance and art. Elders employed by the program provide support and assist resident to recognise, restore and value cultural links with their land and history.

The Committee note that this service is a diversionary program and is not a residential rehabilitation service and as such should not be counted as such a service in our region.

Rekindling the Spirit Greg Telford, CEO of Rekindling the Spirit presented to the Committee of his personal and professional experiences of the specific challenges facing the Aboriginal communities in our region. The vision of Rekindling the Spirit is for a world where Aboriginal Communities are free from social injustice, substance misuse, family violence and child abuse. Rekindling the Spirit offers services directly to Aboriginal men, women and families that relieve poverty, distress, sickness, destitution, trans-generation trauma and other misfortunes. They offer counselling, assistance, education and supplementary services that focus on reducing the occurrence of domestic and family violence and child abuse and on promoting healing and wellbeing within families and the community.

Namatjira Haven Namatjira Haven is an Aboriginal community controlled organisation providing residential healing programs for Aboriginal adult men requiring assistance in dealing with problematic substance use and underlying and associated issues. The centre currently has 14 beds and is located on NSW North Coast 3.5kms from Alstonville, 25 minutes or so from Lismore. Namatjira Haven is a

16 The impetus for the establishment of Balund-a was the Royal Commission into Aboriginal Deaths In Custody, 1987. The property is situated on 534 hectares and also operates as a farming and beef cattle property giving the residents the opportunity to develop agricultural skills. The length of stay at the program varies according to individual needs however a minimum period of 6 months is required. Programs address specific areas of risk to assist on improving life skills and reintegration into the community, for example, cognitive based programs, drug and alcohol, anger management, education and employability, domestic violence, parenting skills and living skills.

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modified therapeutic community to allow for total cultural safety and significance in the use of cultural ways of healing. Namatjira Haven is a member of NARHDAN (NSW Aboriginal Residential Healing and Drug and Alcohol Network) and operates under a Model of Care developed by all our NSW Aboriginal residential services.

“Our model is healing through culture and country. Aboriginal Residential Healing/Rehabilitation Centres recognise that healing is not just related to the wellbeing of the individual, but also the wellbeing of the broader community, thus acknowledging the interconnectedness between social, cultural, spiritual and environmental influences of health. These elements are embodied in the red centre of the circle because they are applied across all the other five core treatment components (see fig 2).” – Dian Edwards, Manager, Namatjira Haven Ltd.

Why we need culturally appropriate residential rehabilitation services for Aboriginal women and for women and children The Committee noted the gap in the sector in our region for residential rehabilitation centres for women and children for both Aboriginal and non-Aboriginal women. The Committee noted the challenges facing women with substance use disorders who are not able to access much needed residential rehabilitation services because they have children who they cannot leave. The Committee note there are women only services located in NSW but they are too far away for our community to access. The Committee further notes that many of these rehabilitation centres prioritise local residents over out of town ones and notably, they are not Aboriginal services. The Committee notes there has been a recent announcement that the Central Coast has been granted funds for an Aboriginal women’s service but no

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children are permitted. The Committee notes that Kempsey recently lost its Aboriginal service.

“We need rehabs that can meet the needs of young Aboriginal men and women between the age of 16 and 21 years, that haven’t been caught up in the Juvenile Justice or Community Corrections system, where they can reflect on alcohol and other drugs and how they implicate people’s ability to move forward, where childhood trauma can be addressed, and the seeds of change can be planted for a constructive future, through education and employment initiatives. Along with this we also need rehabs where adult men and women, who have been caught in the Justice and Community Corrections systems, can start addressing their trauma background, the recidivism cycle, and learn new ways of interacting with the world and what it has to offer. We need to start thinking about how we can do this differently, incorporating culture, adult responsibility to self, children, family and community, along with looking at our social and emotional maturity” – Greg Telford, CEO, Rekindling The Spirit

“We do need residential rehab centres that are culturally appropriate and culturally aware but most importantly we need rehab centres that have a range of specialists services for an absolute wrap around holistic approach to provide better treatment to make positive long term sustained changes in these users lives. We need rehab centres for the women and children so that their bonds can be rebuilt if broken, so that the mothers have a sense of maternal worth and so the children have a sense of how much they mean to their mothers...it would definitely strengthen the mother’s will to want to continue and succeed with the rehab processes. It would give them a reason to hope and to want to continue with rehab.” – Patricia King - Proud Descendant of Widjabul People Within the Bundjalung Nation and member of Lismore City Council Aboriginal Advisory Group.

Why we need Dual Diagnosis residential rehabilitation services Regional statistics pertaining to mental health indicators (such as psychological distress, intentional self-harm and suicide) reveal that Northern NSW has a greater burden of mental health concerns compared to much of NSW.17

17 HealthStats NSW (website), Accessed 30 May 2015, h p://www.healthstats.nsw.gov.au in Northern NSW Mental Health Integration Plan 2015-2018.

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Aboriginal populations have greater socioeconomic disadvantage, suffer more emotional and social distress, have less access to culturally appropriate services, and have a higher incidence of comorbidity with decreased access to primary health care services.18

The Committee notes the gap in the sector for residential rehabilitation services that cater to the many individuals with a dual diagnosis in our region – that is a mental health diagnosis and a substance use disorder diagnosis. Individuals who experience dual diagnosis are affected in different ways and therefore have individual needs. Dual diagnosis adds complexity to assessment, diagnosis, treatment and recovery, and can be associated with increased incidences of relapse. For many individuals with dual diagnosis, standard residential rehabilitation services offer a structured and therapeutic live-in environment, emphasising self-help and peer work to support reintegration into community living. However, some individuals experiencing multiple complexities related to dual diagnosis are not well accommodated in standard services – these clients may require a higher level of clinical support and targeted intervention to meet their treatment needs.19 To address this treatment gap, funding for current rehabilitation centres to cater for specialist dual diagnosis residential rehabilitation services and further centres catering to this high need is required.

“The Buttery has been delivering services in the Alcohol and Other Drugs (AOD) sector in the Northern Rivers since 1973. Comorbidity has always been a feature of people seeking AOD treatment. Estimates suggest that 75% of entrants to AOD treatment have a co-occurring mental health condition.20 The same estimates suggest that approximately 50% of people with a psychotic disorder have a Substance Use Disorder (SUD).21 The Buttery has been working with people with co-occurring mental health and AOD problems since its beginnings. Due to the complex nature of co-existing condition such as SUD and Mental Health issues and the needs of the client group we often find ourselves in situations where clients do not meet eligibility criteria. We are not funded to provide on-site medical staff who can monitor and dispense psychotropic and other medications. Some people are referred who also have complex medical conditions due to the nature of antipsychotic medication side

18 Northern NSW Mental Health Integration Plan 2015-2018. 19 www2.health.vic.gov.au/alcohol-and-drugs/aod-treatment-services/aod-residential-treatment 20 Slade, et al (2009) The mental health of Australians 21 Report on the 2007 National Survey of Mental Health and Wellbeing. Department of Health and Ageing, Canberra.2. ibid

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effects and the burden of disease often experienced by people who have co-existing conditions, such as diabetes, Hepatitis C and HIV, Obesity. These client populations often come with their own specific set of needs that also create issues and difficulties when trying to mix populations with differing pathology and psychopathology. The discussion needs to be not just about adding more residential rehab beds, but looking specifically at the types of service requirements to meet the needs of specialised client populations. These should include more severe mental health (co-morbid services), indigenous women specific, women’s, women & children and family services should all be considered as Programs in their own right as each carries their own set of considerations and needs that do not always just fit within a general population service.” – Leone Crayden, CEO, The Buttery.

Why we need a Youth and Adult Koori court The Committee agree there is a need for a specialised Koori court in our region. There are now two Koori courts in NSW. The Koori court operating one day a week in Parramatta that has just completed the first 12-month trial and the new Koori court recently launched in Surry Hills. The Committee notes that more than 60 young Aboriginal people have taken part in the Paramatta Youth Koori Court since 2015, when it began operating one day a week at Parramatta Children’s Court. NSW Justice note that the Youth Koori Court increases Aboriginal involvement in the delivery of justice, ensuring outcomes are culturally relevant and have more impact on the offender.22 23 The involvement of elders, who sit alongside the Magistrate and the individual is far less intimidating than the regular westernised courts and is based on principles of therapeutic justice – focusing on the criminogenic needs of the participant. Participants are linked with support agencies and are case managed with plans to ensure compliance.

22 http://www.justice.nsw.gov.au/Pages/media-news/media-releases/2017/$220000-funding-boost-for-Youth-Koori-Court.aspx 23 https://crimlawcommittee.wordpress.com/2017/03/05/trial-of-the-new-nsw-youth-koori-court-success/ There has not yet been a formal evaluation carried out on the youth Koori court but initial reports suggest its success in reducing recidivism rates and increasing employment and stable accommodation. In addition, the cost of the Youth Koori court has led to a net saving to NSW of $36,540.

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“Youth and Adult Koori Courts, may assist Magistrates and the community to start aligning community services with clients to start addressing offending behaviour, break the Recidivism cycle and steer the individuals towards programs that assist them to address their under lying issues, that have them caught in the justice system. In all programs addressing anti-social behaviour, there needs to be a component of Social and Emotional Well Being, assisting individuals to understand the impact their behaviour has on those close to them, along with the wider community, especially children who witness the antisocial impacts. The current punitive system isn’t working. This could save the courts time and money in the long term, along with breaking the cycle of over representation of Koori’s in the correctional centres, and the Koori community knowing that there is something being done about trying to break this ongoing dilemma” – Greg Telford, CEO, Rekindling the Spirit

“There is a real need for both an Adult and Youth Koori Court that has Aboriginal people of both ages involved because they have a better understanding of how to relate to their own people in a way that would look at their situations more realistically and positively encourage them to 'want to make better choices and change their lives for the better'. Rather than just being dealt with in the general legal system.”– Patricia King - Proud Descendant of Widjabul People Within the Bundjalung Nation and member of Lismore City Council Aboriginal Advisory Group.

“There are certainly enough adult and young Aboriginal persons before the courts in this region to support a Koori court that operates one day a week. For example, Casino court operates on Wednesday and despite the Aboriginal population in Casino being about 7%, our clients make up about 70% of the court list on most Wednesdays, and that’s just the Casino court experience. The devastating Aboriginal incarceration statistics for our region suggest a need for a Koori court for both young and adult individuals. It’s been 28 years since the Royal Commission into Aboriginal Deaths in Custody. Do we really need a business case? We have the devastating statistics, we know the Koori courts work, we know they save money. Why can’t we just get one happening?” – Councillor Eddie Lloyd, Committee Chair, Trial Advocate, Aboriginal Legal Service. “Having a Koori and drug court would assist defendants to be able to deal with the underlying issues behind their offending behaviour. This would ultimately lead to the reduction of the over

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incarceration of Indigenous people and help people to become the functional members of the community that they want to be” – Binnie O’Dwyer – Solicitor – Aboriginal Legal Service

“The Northern Rivers and Coast community is in a unique position regarding it’s diverse Aboriginal community, but sadly, there is an over representation of Aboriginal and Torres Strait Islander people in our Court system. This fact has been evident for years, and notwithstanding attempts by lawmakers, Courts and Parliament to look at the reasons for this over-representation, the statistics are still shockingly high. Unless we take a proactive approach to this issue, these numbers will continue to exist, and potentially rise, and as a community this is an unacceptable inevitability. The operation of a Koori Court in this region would enable the issues faced by Aboriginal offenders to be dealt with by community; in an appropriate and measured way. The current system of law does not appear to be adequately or appropriately dealing with indigenous offenders. The pilot Koori Courts in Sydney appear to have had a multi-disciplinary and whole of community approach, with resounding successes. Our community is a vibrant, innovative and well-meaning community, in which such a Court would fit with the ethos of the community, whilst meeting the law and order expectations of the community. It would demonstrate a community that is willing to stand up and take responsibility for the issues it faces, whilst having our clients in the system also taking that opportunity within their community structures” - Sophie Anderson, Barrister, Criminal Law – Commercial Bank Chambers – Lismore

Why we need Justice Reinvestment Initiatives Justice Reinvestment or ‘JR’ is the concept of diverting funding away from prisons and into community so that citizens can connect with their community, and break the cycle of incarceration. JR is data driven, place-based, community led and economically sustainable. It’s about investing locally where crime is occurring to address the particular problems facing individuals and communities. Justice reinvestment reduces imprisonment rates while making communities safer. Evidence shows strategic community-driven investment in localised early intervention, prevention and diversionary solutions can reduce crime, build local capacity and strengthen local communities. If there’s less crime, there’s less imprisonment.

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There are a number of factors, unique to Australia, which have led the way to justice reinvestment:

• Indigenous Australians are underrepresented in diversions by courts to drug and alcohol treatment facilities.

• Indigenous people only make up 2.5% of Australia’s population but figures now show 26% of adult males in prison are Indigenous, 31% of adult females in prison are Indigenous and 49% of young people in juvenile detention are Indigenous.

• A recent study by Deloitte Access Economics found that $111,000 can be saved per year per offender by diverting non-violent Indigenous offenders with substance use problems into treatment instead of prison. A further $92,000 per offender in the long term could be saved due to lower mortality and better health related quality of life outcomes.

• Each year there are over 30 000 new prison receptions and over 150,000 movements among prisoners in New South Wales.

• Despite anecdotal evidence that injecting drug use occurs in prisons, not one Australian prison has a needle and syringe program operating

• Australia’s prison population has increased 30% in the last decade • Recidivism rates exceed 50 per cent. • Indigenous women are the fastest growing group within Australian

prisons. The Committee support community led initiatives to address substance abuse and crime in our region. On 25 July 2018, Tracey Kristiansen from 3V Consulting presented to the Committee about Justice Reinvestment and presented a case study of the Maranguka Justice Reinvestment project in Bourke. The Maranguka Justice Reinvestment project emerged as Bourke was concerned about the number of Aboriginal families experiencing high levels of social disadvantage and rising crime. Alistair, a member of the Bourke community noted the following:

“Kids were being taken away. Too many of my community were being locked up. Families were being shattered, again and again,” says Alistair Ferguson, locally born and bred and now overseeing the justice reinvestment project in Bourke. “And this was happening despite the huge amount of money government was channelling through a large number of service organisations in this town.”

“So we started talking together. We decided that a new way of thinking and doing things needed to be developed that helped our children. We decided it was time for our community to move beyond the existing service delivery model, a model which had clearly failed.”

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“We developed the Maranguka proposal with a clear focus on creating better coordinated support to vulnerable families and children in Bourke through community-led teams working in partnership with existing service providers, so that together we could look at what’s happening in our town and why Aboriginal disadvantage was not improving, and together we could build a new accountability framework which wouldn’t let our kids slip through.”

“And then we heard about justice reinvestment and it was like all the stars suddenly aligned,”

On 27 November 2018, KPMG conducted an Impact Assessment of the Maranguka Justice Reinvestment Project.

Key findings of the report included improvements in:

• Family strength: 23% reduction in police recorded incidence of domestic violence and comparable drops in rates of re-offending

• Youth development: 31% increase in year 12 student retention rates and a 38% reduction in charges across the top five juvenile offence categories

• Adult empowerment: 14% reduction in bail breaches and a 42% reduction in days spent in custody.

As a result of these achievements, and achievements in other areas, KPMG estimated an economic impact of $3.1 million in 2017 – and if just half of the results achieved in 2017 continued, an additional impact of $7 million.

Of this, approximately two thirds relate to impact to the justice system and one third is broader economic impact to the region.

In March 2019, the Commonwealth and New South Wales Governments announced $1.8 million in funding to support the continuation of the Maranguka Justice Reinvestment project in Bourke. Following her presentation, Tracey spoke of how JR can result in real outcomes for our community and provided us with the statistics below which suggest our region has the business case and need for such initiatives. What the statistics show is a devastating proportion of our incarcerated people are from the Aboriginal community. In the Richmond Valley, which includes Casino, 32 of the 48 individuals incarcerated are Aboriginal.

The statistics of our region

The cost of incarcerating members of our region in custody is $70,065.90 per day.

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Lismore LGA (includes Nimbin, The Channon) The population of the Lismore LGA is 43,816. The below statistics represent the incarceration rates of the Lismore LGA for adults and juveniles:

• 79 adults incarcerated (44 non-indigenous, 35 indigenous) • $17,652.90 incarceration cost per day

o $13,651.20 cost of adults in custody per day o $4,001.70 total cost of youths in detention per day

Richmond Valley LGA (includes Casino) The population of the Richmond Valley is 23,195. The below statistics represent the incarceration rates of the Richmond Valley LGA for adults and juveniles.

• 48 adults incarcerated and 1 juvenile (16 non-indigenous, 32 indigenous)

• $9,628.30 incarceration cost per day – which is made up of the following:

o $8,294.40 cost of adults in custody per day o $1,333.90 cost of youths in detention per day

Ballina LGA (includes Wardell, Alstonville, Lennox Head and Ballina) The population of Ballina is 43,064. The below statistics represent the incarceration rates of Ballina for adults and juveniles.

• 35 adults incarcerated (18 non-indigenous, 17 indigenous) • $8,715.80 incarceration cost per day – which is made up of the

following: o $6,048 cost of adults in custody per day o $2,667.80 total cost of youth in detention per day

Kyogle LGA (which includes Wiangaree, Grevillia, Woodenbong, Muli Muli, Old Bonalbo, Bonalbo, Tabulam, Mallanganee and Mummulgum) The population of the Kyogle shire is 8,927. The below statistics represent the incarceration rates of the Kyogle shire for adults and juveniles.

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• 33 adults incarcerated (13 non-indigenous, 20 indigenous) • $5,702.40 incarceration cost per day

o $5,702.40 cost of adults in custody per day

Byron Bay LGA (includes Suffolk Park, Byron Bay, Mullumbimby and Ocean Shores) The population of the Byron Bay area is 33,339. The below statistics represent the incarceration rates of the Byron Bay are for adults and juveniles.

• 38 adults incarcerated and 0 juveniles (26 non-indigenous, 8 indigenous)

• $6,566.40 incarceration cost per day o $6,566.40 costs of adults in custody per day

Tweed LGA (includes Pottsville, Hastings Point, Kingscliff, Murwillumbah, Tyalgum and Uki) The population of the Tweed is 94,547. The below statistics represent the incarceration rates of the Tweed for adults and juveniles.

• 103 adults incarcerated and 3 juveniles (71 non-indigenous, 35 indigenous)

• $21,800.10 incarceration cost per day – which is made up of the following:

o $17,798.40 cost of adults in custody per day o $4,001.70 cost of youths in detention per day

The source of this data is: http://www.justreinvest.org.au

“The data within our region provides a foundation for the need to try a new approach. The strong leadership within the region will help in the commencement of community engagement. The stakeholder members of Lismore City Council’s Social Justice and Crime Prevention Committee bring so much expertise and on the ground experience about local needs to the table. They are passionate, motivated and ready to put in the hard yards to address the challenges faced. If the Committee were given the opportunity to continue, I believe they will be successful in establishing a Justice Reinvestment project that will make a real difference to the community and will show other Council’s what is possible when you engage community members on community issues.” Tracey Kristiansen, 3V Consulting.

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“The success of the Justice Reinvestment program in Bourke, especially when it comes to the reduction of crime, is testament to the power of the community when it comes together to address issues in a holistic as opposed to a crime and punishment way. The Northern Rivers is crying out for this type of program. Clearly the current focus of criminalising people is not helping anybody and we need to look to innovative and creative ways to keep indigenous people out of jail such as justice reinvestment projects” – Binnie O’Dwyer, Solicitor, Aboriginal Legal Service “Lismore has a great deal of empathy for the cohort of individuals caught in the cycle of AOD Abuse, Domestic and Family Violence, and frequenting the Justice System by their offending behaviour. If the area had the opportunity to look at Justice Reinvestment, I am sure that we could come up with a program that could meet numerous needs, and satisfy the Government that we are using their funds productively. I am sure that Lismore like any other rural community could use the Justice Reinvestment Initiative to its benefit by having the opportunity to work collaboratively with the Justice System, Community programs, that could work together to assist the participants to meet the needs of Justice system, address their offending behaviour, and their own issues that keep them involved with either using Alcohol and other Drugs, and being involved with the Justice System or FACs” – Greg Telford, CEO – Rekindling the Spirit.

“There has been limited cost benefit analysis completed recently outside the Just Reinvest NSW analysis. The figures provided by Just Reinvest show costs per day for 79 adults is $18,616.35 total cost incarceration per day for Lismore alone. This equates to $235 per day per person. In comparison The Buttery costs for residential rehabilitation per bed is $63 per day. It is nearly 4 times more costly to incarcerate a person than to offer them residential rehabilitation and treatment. The cost to imprison an Aboriginal and Torres Strait Islander person is even greater with the cost per person of 12 months in prison is $114, 832, with the derived expenditure. This is equivalent to a cost per prisoner per day of $315 for an Aboriginal person. The facts according to Foundations Recovery Network are as follows: Initial drug treatment is less expensive than incarceration.

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• Costs related to incarceration are cut because people who are in recovery are less likely to commit expensive crimes or be arrested again.

• Because long-term health of each individual will be improved, the cost of healthcare for uninsured patients will be drastically reduced.

• Costs of law enforcement and court costs will be cut when crime rates drop and fewer arrests occur

No matter how expensive treatment is, it’s nothing compared to the costs that add up over years of drug addiction, including:

• Medical care and health costs for overdose, accidental injury under the influence, and chronic illness caused by drug use

• Bail, court costs, lawyer fees, and other legal fees caused by drug-related arrest

• Lost productivity due to active addiction, including a lowered ability to work and bring in money

• Cost of supporting someone who is unable to support themselves

• Cost of supporting any children born to the addicted person

• Cost of long-term health complications due to substance use, that often appear later in life if a person manages to avoid overdose or immediate illness” – Leone Crayden, CEO, The Buttery.

Recommendations from the Upper House Inquiry on the Provision of Drug Rehabilitation Services in Regional, Rural and Remote New South Wales that the Committee supports

The Committee supports the following recommendations made at the NSW Upper House Inquiry on the Provision of Drug Rehabilitation Services in Regional, Rural and Remote New South Wales.

Recommendation 1

That the NSW Ministry of Health implement, as a matter of urgency, a population-based planning tool, such as the Drug and Alcohol Service Planning model, to ascertain what rehabilitation services and how many beds are required throughout New South Wales, and in which regions.

Recommendation 2

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That the NSW Government significantly increase funding to drug and alcohol-related health services, and use the data gathered through the population-based planning tool as outlined in recommendation 1, to:

• tender for the establishment of more residential rehabilitation services throughout regional New South Wales, including facilities for women and children, Aboriginal people, and young people including those aged 13 to 16

• tender for the establishment of more detoxification services throughout regional New South Wales, including facilities for Aboriginal people and young people

• investigate the benefits of establishing multi-purpose facilities in regional areas that provide detoxification, residential rehabilitation and outpatient services

Committee Comment

“There is nowhere for people under 18 to detox in our region. Sadly, so many of our youth clients and community members are experiencing alcohol and substance use disorder, particularly methamphetamine.” – Councillor Eddie Lloyd, Committee Chair and Trial Advocate, Aboriginal Legal Service

Committee Comment

“The current challenge with transition from detox to residential rehab is bound in the inequity of available beds and the clear disparity between lengths of stay required for each. It is not that there is a shortage of detox beds, but rather the locations of said beds and the ability to align detox stays with an entry date for a long-term residential rehab. Currently, if a potential participant is located outside of the area they are required to attend a detox facility closer to where they reside before making their way to the residential rehab. This does pose risks for potential clients as they are sometimes required to take an additional day or two to travel in order to take up their rehab bed. As an example, we have the detox facility here in Riverlands. The next closest dedicated detox beds in NSW are located in Newcastle. The accessibility of adequate detox services is a major problem for regional and rural areas. There is very little supervised in-home detoxification occurring in the area.” - Leone Crayden, CEO, The Buttery. “Detox facilities is the primary step towards rehabilitation for many people. However, a week-long pharmacological detoxification is only going to rid the individuals system of the substance. To ensure the risk of relapse is minimized, individuals

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then need to undertake rehabilitation where they can learn new behaviours through cognitive behavioural therapies. It is in detox that many individuals begin to get some clarity and insight and begin to become motivated to get clean. It is vital that this small window of opportunity can be capitalised. Unfortunately, the utility of our only detox facility is compromised unless there are beds available in residential rehabilitation centres immediately following detox so that the window of clarity of an individual can be capitalized and treatment facilitated. I recently had a client who undertook a 7-day detox only to be discharged into the community with no supports and of no surprise to me, the individual relapsed and re-offended. That felt like a waste of detox resources and I felt the gap in services let this individual and the community down. Following the relapse and reoffending, the client was bail refused and now has no access to rehabilitation until his eventual release from custody. This could have been avoided if there was a bed available in a rehab.” Councillor Eddie Lloyd, Committee Chair and Trial Advocate, Aboriginal Legal Service.

• fund local social services and Aboriginal Medical Services in regional, rural and remote New South Wales to assist in transporting patients to and from drug and alcohol treatments

• provide incentives for qualified drug and alcohol professionals to relocate to regional areas and to up-skill workers based in regional areas

• work with universities, in collaboration with the Royal Australasian College of Physicians and the Royal Australian and New Zealand College of Psychiatrists, on initiatives to develop more specialists in the drug and alcohol field including specialist from the Aboriginal community

Committee Comment

The committee does not support the following recommendation from the Inquiry. The reasons are articulated by the CEO of the Buttery below.

• investigate the efficacy of subsidising beds in regionally-based private, for-profit residential rehabilitation facilities to ensure more people from regional areas can access rehabilitation.

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“Private rehabilitation may be a good option especially for those who can afford it and those who can utilise health funds. However, there is no regulation over the operators who do not use private health funds. No accreditation processes, no quality controls and no evidence that suggest they deliver successful outcomes. Private wellness and retreat type programs are increasing as a choice for many people who want time out. The programs to work with people with AOD issues should be evidenced based, clinically governed with excellent partnerships with the Primary Health Networks, the NSW Local Health and Districts and industry bodies.

Subsidy for private clinics poses risk of unscrupulous operators entering the market and taking advantage of vulnerable people” – Leone Crayden, CEO, The Buttery

“There is a need for a watchdog to protect vulnerable families from being financially ruined. They need to know what they are buying” – Dian Edwards, Manager, Namatjira Haven Ltd.

Recommendation 3

That the NSW Ministry of Health, as a matter of urgency, establish a central register for New South Wales of all available beds and facilities for drug and alcohol rehabilitation, which:

• includes real-time data concerning wait lists and wait times; • encompasses private health and medical services; • is publicly available as a resource for service providers, legal

professionals and the community.

Recommendation 4

That the NSW Government conduct a review of the Drug Court and the Magistrates Early Referral Into Treatment program, including the feasibility of establishing them in additional regional areas.

Recommendation 6

That the NSW Government:

• commit to providing funding grants to non-government drug and alcohol-related service providers that run for a minimum of three years, with the option for a two year extension;

• advocate through the Council of Australian Governments for the Australian Government to commit to the same practice.

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Committee Comment

The members of our committee agreed that funding for 10 years should be secured. The members vocalised the need for all politicians to play their part in de-politicising this health issue by committing to 10 year long term funding and not funding dependent on who is in power.

“Funding of programs for the Lismore community is an ongoing issue, I have watched over the past twenty years how programs have to change tact to secure funding for another couple of years, then change tact again to secure funds for a further few years. Whilst this is occurring it is difficult for the organisation, to measure its own success of effectiveness on clients, let alone developing the evidence to say it is working well.

With security funding of up to 10 years, services would be able to plan and monitor their programs more effectively, evaluate the evidence that what they are doing works, prepare and align programs with more community participation, and try and get answers coming from the inside out, not the outside in. Not be going cap in hand every few years to another funder, seeking funds for the next few years” – Greg Telford, CEO, Rekindling the Spirit

“Organisational needs Currently funding for Alcohol and other Drugs residential rehabilitation, community outreach programs are funded from a number of sources including the:

• Commonwealth with funds though the Primary Health Networks (PHN’s) or directly from the Department of Health • State funds primarily though the NSW Ministry of Health

In most instances there is a competitive tendering process which gives approximately 2-3 week turnaround time to make an application or tender. Funding is often for three years however some funds are for lesser periods such as twelve to sixteen months. In some instances historical funding greater than ten years is only funded on a year-by-year basis. Another complication is that funded programs may be extended but often organisations are not notified about the extension until as little as a month or two before the end of the program. This creates further issues in the following areas:

• Retention of staff • Burden of recruitment and training costs • Staffing and security of tenure, good staff often move on • Unnecessary burden of contracting and renewing contacts for staff

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• Difficulty in budgeting, cash flow forecasts, Workcover wages estimates.

Client Needs Sustainability in service provision is crucial in developing a care plan with regards to continuum of care. Short funding cycles invariably result in service provision changes which are quite often politically motivated and not performance based. These changes then impact on the ability of clients to receive adequate ongoing treatment as the services being offered are consistently changing, creating ever opening gaps that clients fall through. A stable long term contract in all service areas better supports integration of services and relationship building to develop the pathways of care for clients that provide continuity and stability, which in of themselves are crucial elements in supporting ongoing recovery efforts of clients. The obvious advantages are also in sustainability and security of workforce which in turn has a positive effect on client’s outcomes as a solid stable workforce is much more productive and impacting on client wellbeing than the constant state of uncertainty of 12 month roll over or even 3 year rotating contracts.” - Leone Crayden, CEO, The Buttery.

Recommendation 7

That the NSW Government establish a standards framework for the private, for-profit residential rehabilitation industry.

Recommendation 8

That the NSW Government ensure that public housing tenants who undertake residential drug rehabilitation or detoxification, not exceeding 12 months, do not lose their housing while undergoing treatment.

Committee Comment

“There is most definitely a genuine need for reforms within the various housing service providers, policies, procedures and guidelines when they have tenants that have been or are in long-term residential rehab and they still have their housing to return to afterwards. However, no tenant that has undergone residential rehabilitation should have to return to the house where they had been previously experiencing substance use disorder. They deserve a fresh start to their lives and the housing system should ensure they are housed in appropriate housing, in appropriate

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locations to promote the continued rehabilitation of individuals who need to be surrounded by positive peers and influences.” – Patricia King - Proud Descendant of Widjabul People Within the Bundjalung Nation and member of Lismore City Council Aboriginal Advisory Group.

Recommendation 9

That the NSW Government

• acknowledge the health, social and economic benefits of prevention of drug and alcohol abuse;

• investigate the efficacy of implementing a state-wide school nurse program which includes targeting young people with preventative action and support.

Recommendation 10

That the NSW Ministry of Health report to the NSW Parliament annually on the progress of the implementation and outcomes of the Good Health – Great Jobs: Aboriginal Workforce Strategic Framework 2016-2020 in regards to the drug and alcohol rehabilitation sector.

Recommendation 11

That the NSW Government investigate the efficacy of establishing a scheme to establish a full time local Aboriginal trainee position alongside every skilled position recruited in areas with a significant Aboriginal population.

Committee Comment

“If the NSW Government could initiate a Traineeship where every service requiring a skilled qualified worker to operate any machinery, service systems or program, took on an Aboriginal Trainee. I am sure that with time we would definitely overcome some of our long-term unemployment problems, besides building self-esteem, and a sense of belonging into a minority group, that have been sitting on the outer since colonisation” – Greg Telford, CEO – Rekindling the Spirit.

Recommendation 12

That the NSW Government trial adult and youth Koori Courts in various regional New South Wales locations for a period of twelve months and conduct a comprehensive review to determine the appropriateness and need for further Koori Courts in other locations in regional New South Wales.

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